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General NPI Number Information
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NPI Number | 1316167463
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Entity Type | Organization
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Legal Business Name | EAR NOSE AND THROAT SPECIALISTS OF WEST CENTRAL OHIO
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 770 WEST HIGH ST SUITE 480
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City | LIMA
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State | OH
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Zip | 45801
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Country | US
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Telephone | 419-227-9500
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Fax | 419-227-9503
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Provider Business Mailing Address
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Address Line | 770 WEST HIGH ST SUITE 480
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City | LIMA
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State | OH
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Zip | 45801
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Country | US
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Telephone | 419-227-9500
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Fax | 419-227-9503
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. RANDALL ELLIOTT DALTON
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Credential | MD
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Telephone | 419-227-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35083245
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License Number State | OH
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